The Role of Information/Communication Technology and Monitoring/Surveillance Systems in Bioterrorism Preparedness

Slide Presentation by Michael Shannon, M.D., M.P.H.

On October 21, 2003, Michael Shannon, M.D., M.P.H., made a presentation in the Web-assisted Audioconference entitled The Role of Information/Communication Technology and Monitoring Surveillance Systems in Bioterrorism Preparedness.

The is the text version of Dr. Shannon's slide presentation. Select to access the PowerPoint® slides (763 KB).

The Role of Information Technology in Improving Syndromic Surveillance and Decision Making

Michael Shannon, M.D., M.P.H.
The Center for Biopreparedness
Children's Hospital/Harvard Medical School
Boston, MA

Slide 1

What is Syndromic Surveillance?

• Syndromic surveillance is the term for the active monitoring of a disease cluster.

Slide 2

Information Technology's Role in Improving Syndromic Surveillance

• Information technology offers several valuable features for syndromic surveillance:
  • Electronic nature.
  • Ability to conduct real-time surveillance.
  • Value of its monitoring data that are routinely collected in daily social activities.

Slide 3

Key Steps in Developing Bioterrorism-Based Automated Decision Support Systems

• Compilation of signs/symptoms of the disease of interest.
• Delphi group evaluation of signs/symptoms, temporal features and differential diagnosis.
• Construction of prior probabilities algorithms (back end).
• Output = differential diagnosis along with probabilities.

Slide 4

Information Systems Created or Under Development by the Center for Biopreparedness at CHB

• Syndromic Surveillance
  • EDScope.
  • AEGIS.
  • Boston data linkage project.
  • PECARN data linkage project.
  • School monitoring project.
• Automated Decision Support
  • The Bioagent Diagnosis Program.

Slide 5

This slide contains a screen shot of an interface for a surveillance system to be used by an Emergency Department. On this screen is the name of the program, Emergency Department Scope, and a chart that is to be filled in with information. The chart shows the number of forecasted vs. the number of actual visits to the Emergency Department for the past week. This particular chart contains information from the week September 12-18. Each row in the chart represents a different diagnosis (e.g., dermatological, infection, respiratory, etc.). There are columns for each day, and under each day are two more columns containing numbers of actual and forecasted visits.

Slide 6

The Bioagent Diagnosis Program

This slide contains a screen shot of a worksheet that can be used to detect possible bioagent causes for presenting symptoms. The sheet contains input fields for maximum number of days any finding has existed, maximum time since suspected exposures, and age of patient. Below these input fields is a listing of chief complaints, with the instructions to place a check near the chief complaint that a patient presents. Chief complaints can include: general—chills, fever or malaise; respiratory: cough, hemoptysis, or rhinorrhea; cardiovascular—chest pain; heme—bleeding; GI—abdominal pain, GI bleeding, diarrhea; neuro—confusion, dizziness, or headache; and musculoskeletal— arthralgia, backache, and myalgia.

Slide 7

Possible Bioagent Causes for Presenting Symptoms

Case: (symptoms existing a maximum of 2 days)
Present: Delirium Fever Meningitis Shock

1. Anthrax (Inhalational) in the late stage Probability: .999
   • Supported by Shock (9000) Meningitis (5000) Fever (45.0).
   • Unexplained by this: Delirium (.0001).
   • Unknowns that would be expected: Chest pain (.0.9) Cough (0.9) Cyanosis (0.9) Malaise (0.9) Resp distress (0.9) Sepsis (0.9) Stridor (0.9) Vomiting (0.3).
2. Encephalitis in the early stage Probability: .000
   • Supported by Delirium (9000) Fever (45.0).
   • Unexplained by this: Shock (.0001) Meningitis (.0001).
   • Unknowns that would be expected: Cranial palsy (0.9) Headache (0.9) Paralysis (0.9) Seizure (0.9) Stiff neck (0.9) Vomiting (0.5).
3. Plague, pneumonic in the late stage Probability: .000
   • Supported by Shock (9000) Fever (45.0).
   • Unexplained by this: Meningitis (.0001) Delirium (.0001).
   • Unknowns that would be expected: Cough (0.9) Headache (0.9) Hemoptysis (0.9) Pneumonia (0.9) Rash-purpuric (0.9) Sepsis (0.9) Stridor (0.9).

Slide 8

Specific Issues in Pediatric Preparedness

• School preparedness.
• Surge capacity.
• Training of 1st responders in management of pediatric disaster victims.
• Creation of national pediatric disaster response teams.
• Creation of assessment/management tools for mental health sequelae.

Current as of December 2003

Internet Citation:

The Role of Information Technology in Improving Syndromic Surveillance and Decision Making. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/btinfoaud/shannontxt.htm

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